In defense of Beany

MidwestSeashell

What I've gathered from Beany is that it is not so much this one individual that she is commenting on but rather current birth trends in general. She seems to be using this particular case as a platform for discussing the dangers (as she sees them) of unecessary intervention in birth.

Most of the responses have been attacks on her timing, lack of tact and "judgeyness" but few have addressed the meat of her post. 

No one takes joy or satisfaction in a baby in the NICU. That's a senseless and distracting rebuttal to a set of honest and important questions...as I see them:

Are inductions safe?

Are inductions likely to lead to more (and more dangerous) interventions?

Does the amount of inductions we're experiencing reflect a true medical necessity or are we making these choices based on convenience?

Are there long term health (physical/mental) implications from unnecessary birth intrevention?  

How will the increasing amount of augmented births affect the landscape of women's healthcare for future generations?

How can we best support mothers and families before and after these decisions are made?

I don't know the answers to all of these but I'm pretty sure the answer to the last one isn't "by being silent in the name of not being judgemental"

We must trust that this topic comes up again and again not out of spite or the desire to be better than one another but in pursuit of safe births for all babies. 

MidwestSeashell

original thread...

 

https://community.thebump.com/cs/ks/forums/thread/72201884.aspx

 

margeincharge3

I think the problem with Beany's post is the implication that there is one way to birth a baby. That is her choice but it's important to recognize that different women want different things out of childbirth. I think that's one of the biggest problems with opinions on childbirth overall. For some in the NB community, there is a presumption that every woman would choose this way of giving birth if only they have done the research. That's just not true. I believe birth choice is incredibly important, even choices I wouldn't opt for myself.

We can only speak from my personal experience which is why I think personal experiences come up a lot in these kinds of posts. I had wanted an unmedicated birth with my first but I had an emergency c/s due to HELLP syndrome. It was a very necessary c/s that had to be done under general anesthesia. For me, that is the worst birth situation I could imagine. I spent way too long torturing myself over not being able to be awake for my son's birth. Fortunately we had no NICU time.

For my VBAC, I was very insistent on wanting a tolac. My baby was measuring big at the end and my OB was pushing a rcs. It was a very stressful time because I had medical professionals telling me that my baby could be harmed if we had a shoulder dystocia situation. I understood the risks and still chose a tolac. But because of the situation, I had my own limits. Because my baby was measuring big and I was a vbac, I personally wasn't comfortable going past 40 weeks. So if I had gotten to that point, I probably would have scheduled a rcs. I also was open to getting an epidural. The main reason for me was because in the event of an emergent c/s, I didn't want to have to be knocked out again. So even if the risk of an emergency c/s was low, it was simply not a risk I was willing to take. I ended up going into labor at 38 weeks, 6 days. My labor was pretty much an induction because despite my water breaking, it was only the foley bulb and pitocin that caused me to dilate. I also got an epidural after the pitocin. I got my vbac. And my baby was big (9lbs, 11oz). For me, it was a perfect birth.

I bring up my birth experience because all along the way, I made choices that others would judge. Some would judge me trying to vbac a big baby. If something had happened to my son in labor, I am sure there would have been people who blamed me for not scheduling a rcs. Some would judge me for getting an epidural. If I had ended up with a c/s, I'm sure there are some who would have blamed the c/s on the epidural. If scheduled a c/s at 40 weeks, some would judge me for not going all the way to 42 weeks. But at the end of the day they're not me. So when I look at other people's births, I recognize that while I may not make the choices they make, I respect their right to make those decisions.

meltoine

I really do get the sentiment behind trying not to judge individual moms or situations. But the reality is that outcomes of birth for moms and babies in this country are atrocious for a modern, westernized nation, and those atrocious outcomes are directly related to elective inductions and unnecessary sections. If we're going to fix this problem, we have to do it one birth at a time, one mom at a time, one doctor at a time. You can't fix a problem like this by saying "well it must have been what was best for them". The science shows that induction and sections are rarely best and we have to cut our numbers of these procedures down drastically if we want to truly do what is best for moms and babies. This necessarily has to involve taking a hard look at individual cases and determining where we could have done better so we know for next time. 

That said, of course this conversation should be happening in hospital board rooms with OBs every week. It's completely unproductive on a message board, except to hopefully let women know that they do have options and that it is okay to ask questions if they aren't comfortable with their provider's recommendations. Or, even in some cases, that maybe there's a reason they shouldn't automatically be comfortable with their provider's recommendations.

Ideally these changes would come from the OBs themselves, but that's clearly not happening, at least not fast enough. It's less than ideal, but we have to stick up for ourselves and demand what is best for moms and babies.  

MidwestSeashell

margeincharge3:

I think the problem with Beany's post is the implication that there is one way to birth a baby. That is her choice but it's important to recognize that different women want different things out of childbirth. I think that's one of the biggest problems with opinions on childbirth overall. For some in the NB community, there is a presumption that every woman would choose this way of giving birth if only they have done the research. That's just not true. I believe birth choice is incredibly important, even choices I wouldn't opt for myself.

We can only speak from my personal experience which is why I think personal experiences come up a lot in these kinds of posts. I had wanted an unmedicated birth with my first but I had an emergency c/s due to HELLP syndrome. It was a very necessary c/s that had to be done under general anesthesia. For me, that is the worst birth situation I could imagine. I spent way too long torturing myself over not being able to be awake for my son's birth. Fortunately we had no NICU time.

For my VBAC, I was very insistent on wanting a tolac. My baby was measuring big at the end and my OB was pushing a rcs. It was a very stressful time because I had medical professionals telling me that my baby could be harmed if we had a shoulder dystocia situation. I understood the risks and still chose a tolac. But because of the situation, I had my own limits. Because my baby was measuring big and I was a vbac, I personally wasn't comfortable going past 40 weeks. So if I had gotten to that point, I probably would have scheduled a rcs. I also was open to getting an epidural. The main reason for me was because in the event of an emergent c/s, I didn't want to have to be knocked out again. So even if the risk of an emergency c/s was low, it was simply not a risk I was willing to take. I ended up going into labor at 38 weeks, 6 days. My labor was pretty much an induction because despite my water breaking, it was only the foley bulb and pitocin that caused me to dilate. I also got an epidural after the pitocin. I got my vbac. And my baby was big (9lbs, 11oz). For me, it was a perfect birth.

I bring up my birth experience because all along the way, I made choices that others would judge. Some would judge me trying to vbac a big baby. If something had happened to my son in labor, I am sure there would have been people who blamed me for not scheduling a rcs. Some would judge me for getting an epidural. If I had ended up with a c/s, I'm sure there are some who would have blamed the c/s on the epidural. If scheduled a c/s at 40 weeks, some would judge me for not going all the way to 42 weeks. But at the end of the day they're not me. So when I look at other people's births, I recognize that while I may not make the choices they make, I respect their right to make those decisions.

Thank you for your thoughtful response and for sharing your stories.

I compleetely agree that there is no universal "right way" to give birth. Different circumstances call for different measures. What I'm concerned about is that appropriate measures are being applied in those circumstances. 

From your description, the appropriate interventions were put into place and it resulted in the best birth for you. I wish that were the case with the majority of births but I'm not sure that it is.

I also agree that we never know the whole story of a mother's experience and why she makes the choices she does/ What we do know is that our healthcare providers have a direct impact on those choices (as your OB "stressed" you out about the possible dangers of a VBAC) and if the providers are not educated or experienced in natural, unmedicated birth (because so many births are being unnecessarily augmented) they are way less likely to offer the support needed to prepare and execute such a natural birth thereby limiting the options of our daughters and granddaughters.  (holy run-on sentence, batman)

I respect women's right to choose but I feel we need to make sure they truly have options to choose from.  

ridesbuttons

Beany's words:

my stepbrother's wife is 6 days past her due date and is being induced today simply because she is past her due date

i want to clarify that she is not my friend.  she is my stepbrothers wife who i barely know, i have met her maybe 6 or 7 times and are not close

i REALLY want to post something snarky

Her doc scheduled her induction when she was only 1 day overdue

"This is how their conversations went:

Doc: "You will be induced on X date"

Friend: "Ok"

And yes, i do get judgy when i see another case of a woman not questioning decisions made about HER body and HER baby

and i also want to add that the pic she posted of him on facebook is of him in the NICU with a tube up his nose (i guess due to the fluid in his lungs) and this is a direct result of the decision to induce

...and will probably be fed formula instead of breastmilk first, which will make breastfeeding even harder to establish.  It upsets me because his birth didnt have to like this, there was no medical reason

i want to clarify she is not my friend.  she is my stepbrothers wife

YES, my tone is judgemental

 I find it ironic that the majority of the responses to my post are shaming me for being judgemental, while you are all judging me

What I can't stomach out of Beany's post is:

1. She says she is not friends and has virtually no relationship with this woman.
2. Nevertheless she claims to have first hand knowledge of private conversations between the mom and her doctor
3. She claims to know everything about the pregnancy
4. She claims to know why the child is in the NICU, the root cause (induction)
5. She claims to have knowledge of future events (breastfeeding)
6. She finds irony in the responses being judgemental for her being judgemental which, let's face it, is judgemental.

When Beany posts her MD diploma, the actual facts of the pregnancy and the details of the mother/child in question, then maybe I'll have an open mind.

In the meantime, she needs to STFU about this particular set of circumstances and, if she wants to, open a discussion about inductions in general, the empowerment of mothers-to-be and the education of the same.

MidwestSeashell

ridesbuttons:

Beany's words:

my stepbrother's wife is 6 days past her due date and is being induced today simply because she is past her due date

i want to clarify that she is not my friend.  she is my stepbrothers wife who i barely know, i have met her maybe 6 or 7 times and are not close

i REALLY want to post something snarky

Her doc scheduled her induction when she was only 1 day overdue

"This is how their conversations went:

Doc: "You will be induced on X date"

Friend: "Ok"

And yes, i do get judgy when i see another case of a woman not questioning decisions made about HER body and HER baby

and i also want to add that the pic she posted of him on facebook is of him in the NICU with a tube up his nose (i guess due to the fluid in his lungs) and this is a direct result of the decision to induce

...and will probably be fed formula instead of breastmilk first, which will make breastfeeding even harder to establish.  It upsets me because his birth didnt have to like this, there was no medical reason

i want to clarify she is not my friend.  she is my stepbrothers wife

YES, my tone is judgemental

 I find it ironic that the majority of the responses to my post are shaming me for being judgemental, while you are all judging me

What I can't stomach out of Beany's post is:

1. She says she is not friends and has virtually no relationship with this woman.
2. Nevertheless she claims to have first hand knowledge of private conversations between the mom and her doctor
3. She claims to know everything about the pregnancy
4. She claims to know why the child is in the NICU, the root cause (induction)
5. She claims to have knowledge of future events (breastfeeding)
6. She finds irony in the responses being judgemental for her being judgemental which, let's face it, is judgemental.

When Beany posts her MD diploma, the actual facts of the pregnancy and the details of the mother/child in question, then maybe I'll have an open mind.

In the meantime, she needs to STFU about this particular set of circumstances and, if she wants to, open a discussion about inductions in general, the empowerment of mothers-to-be and the education of the same.

I agree that it may not have been the most tactful or considerate way to express her feelings but I still think the central arguments and overall theme of her post deserve honest conversation.  Most of the responses were an attack on her method of bringing these points up and did not address the points themselves.

nosoup4u

MidwestSeashell:

What I've gathered from Beany is that it is not so much this one individual that she is commenting on but rather current birth trends in general. She seems to be using this particular case as a platform for discussing the dangers (as she sees them) of unecessary intervention in birth.

...

No one takes joy or satisfaction in a baby in the NICU. That's a senseless and distracting rebuttal to a set of honest and important questions...as I see them:

No, she really wasn't. She was shaming her stepbrother's wife because she didn't make choices beany agreed with.

Have you had a baby in the NICU before? When jerks write about how a baby is in the NICU and she thinks "this is a direct result of the decision to induce", how is that helpful or relevant for her arguments? It's just going to piss off other people, who have had babies in the NICU because of various interventions. 

MidwestSeashell:

How can we best support mothers and families before and after these decisions are made?

I don't know the answers to all of these but I'm pretty sure the answer to the last one isn't "by being silent in the name of not being judgemental"

 

If she wanted a post about the high rates of interventions/inductions/c-sections, then she would have posted questions similar to yours. Her freaking subject line is "Keeping my mouth shut, but..." and then she proceeds to rake a virtual stranger over the coals. Not really pushing the conversation about maternity care forward. 

There is a difference between questioning the status quo, and just blaming women for their crappy birth outcomes. Learn it, live it, love it. 

Nechie122

I think one thing that gets lost in this discussion is that the US, as a country, is generally risk averse when it comes to medical care. One of our priorities is control, and Atul Gawande had a fantastic piece about modern obstetrics in the New Yorker that's a great read. We're simply a country that thinks more medical care is better and we tend to fetishize the worst case scenario ... e.g. the risks of shoulder dystocia over the risks of csection complications.

I mean, how many of us just on this board continue to go for a pap smear every year even though the guidelines have changed? And remember the uproar when the US Preventative Task Force changed the mammogram screening recommendations?

So it's one thing to say "one doctor, one mother, one birth" at a time, but we also need to make allowances for different values that simply lead people to make a calculation that may not be "evidence based" but speaks to their own personal biases and preferences. And the level of outrage Beany had was disproportionate to what this poor woman actually elected to do and reeked of self righteousness.

nosoup4u

MidwestSeashell:

I agree that it may not have been the most tactful or considerate way to express her feelings but I still think the central arguments and overall theme of her post deserve honest conversation.  Most of the responses were an attack on her method of bringing these points up and did not address the points themselves.

Are you her lawyer? Why do you care so much that she's coming off as a douchenozzle?

meltoine

Nechie122:

So it's one thing to say "one doctor, one mother, one birth" at a time, but we also need to make allowances for different values that simply lead people to make a calculation that may not be "evidence based" but speaks to their own personal biases and preferences.

 Why should we make allowances for people to choose medical procedures that are not evidence based just because they feel like it? We've already fought this fight wrt  prescribing antibiotics for viruses. Not long ago (late90s) doctors were prescribing abx for colds and such because it made parents feel better, like they were doing something for their kids instead of just waiting for them to get better. Well, then we started developing abx-resistant bacteria at alarming rates and the medical community realized that this practice was bad news for the community st large, and over time they stopped the practice. They also continue to look for ways to treat infections without abx, i.e. the new recommendation that came out this week saying that pediatricians should take a wait-and-see approach to treating ear infections instead of automatically prescribing abx, though many parents will still ask for them because they feel better "doing" something. 

Medical care, especially when we pay for it communally (as in group insurance plans or socialized healthcare) has to be about the treatment that is right for the patient, not what will give the patient a warm fuzzy feeling inside at a high cost to our maternal and infant mortality and morbidity rates, as well as our wallets.

Im sorry, but I just don't see room here for making allowances for people's uneducated or miseducated opinions, be those people doctors or patients, but especially wen those people are doctors whom we pay to be educated about these issues. Opinion is not science or fact, and medical decisions need to be based on science and fact.  

Nechie122

meltoine:

Nechie122:

So it's one thing to say "one doctor, one mother, one birth" at a time, but we also need to make allowances for different values that simply lead people to make a calculation that may not be "evidence based" but speaks to their own personal biases and preferences.

 Why should we make allowances for people to choose medical procedures that are not evidence based just because they feel like it? We've already fought this fight wrt  prescribing antibiotics for viruses. Not long ago (late90s) doctors were prescribing abx for colds and such because it made parents feel better, like they were doing something for their kids instead of just waiting for them to get better. Well, then we started developing abx-resistant bacteria at alarming rates and the medical community realized that this practice was bad news for the community st large, and over time they stopped the practice. They also continue to look for ways to treat infections without abx, i.e. the new recommendation that came out this week saying that pediatricians should take a wait-and-see approach to treating ear infections instead of automatically prescribing abx, though many parents will still ask for them because they feel better "doing" something. 

Medical care, especially when we pay for it communally (as in group insurance plans or socialized healthcare) has to be about the treatment that is right for the patient, not what will give the patient a warm fuzzy feeling inside at a high cost to our maternal and infant mortality and morbidity rates, as well as our wallets.

Im sorry, but I just don't see room here for making allowances for people's uneducated or miseducated opinions, be those people doctors or patients, but especially wen those people are doctors whom we pay to be educated about these issues. Opinion is not science or fact, and medical decisions need to be based on science and fact.  

Except I'm not talking about our warm, fuzzy feelings, but about how we weigh the data when we're talking about the risks and benefits for two unique patients, and where the evidence might be slightly at odds.

There are risks in home birth and VBACs. There are risks to inaction too. Shoulder dystocia isn't some fancy thing doctors made up just to scare mothers. Neither is fetal distress or cerebral palsy. YES, absolutely, those conditions have been used to scare women, but again and again, including on this board, you'll hear stories from moms who said, I didn't want to wait till 42 weeks to induce because my mom had a stillbirth after she went over term. Or, like the PP: I chose an epidural because I didn't want to risk another csection under general anesthesia.

Should women not be allowed to make the choices they want, within reason, even if it ultimately means our csection rate is higher than the WHO recommended 10 percent?

ETA: I'm also not sure the antibiotics example is the right one. I'd put routine antibiotics in the same category as routine episiotomies ... a terrible idea.

But there's a ton of gray area. Like fetal monitoring during labor. It's an intervention that raises the risk of csection. OTOH, it can help prevent fetal deaths. And is preventing an additional fetal death worth the added csection risk? That's why I think the cancer screening analogy is the better one. There are risks to both over and under treatment and we each have our own comfort levels there.

Sarra21

I think you are giving Beany too much credit. The greater argument that you generously teased out of her snide disdain is worthy, timely and on point, but the original post lacks all of the thoughtful objectivity you and the other posters bring to the discussion. Beany certainly has a general point here, but the specific intent is to shame a new mom with a NICU baby, to the point that she asks for permission from the peanut gallery to post an unkind comment on the
womans FB page!! She admits that this girl is virtual stranger to her, so I have to point out that there might be mitigating circumstances warranting the induction that Beany, not being even a casual friend, does not know about. Or maybe Beany is spot on, but nothing is accomplished in that gossipy, spitefilled post, other than to embarass an already stressed family. You want to parse the details of womens healthcare in the U.S., do it, but to openly shame and ridicule a stranger's private choices with your nose in the air is indefensible.

AmyRI

meltoine:

Im sorry, but I just don't see room here for making allowances for people's uneducated or miseducated opinions, be those people doctors or patients, but especially wen those people are doctors whom we pay to be educated about these issues. Opinion is not science or fact, and medical decisions need to be based on science and fact.

And what happens when there isn't enough data to really have a good handle on the risks? Or when outcomes are better for moms in one case and babies in another?

Sure wish I had you in the delivery room with me when I had to decide on a cesarean with higher risk for me or a vaginal breech birth with a higher risk for my baby. Did I choose incorrectly for attempting the vaginal birth? Did my provider do me a disservice by presenting me with 2 options, both based on evidence, and letting me choose?

meltoine

AmyRI:

meltoine:

Im sorry, but I just don't see room here for making allowances for people's uneducated or miseducated opinions, be those people doctors or patients, but especially wen those people are doctors whom we pay to be educated about these issues. Opinion is not science or fact, and medical decisions need to be based on science and fact.

And what happens when there isn't enough data to really have a good handle on the risks? Or when outcomes are better for moms in one case and babies in another? Sure wish I had you in the delivery room with me when I had to decide on a cesarean with higher risk for me or a vaginal breech birth with a higher risk for my baby. Did I choose incorrectly for attempting the vaginal birth? Did my provider do me a disservice by presenting me with 2 options, both based on evidence, and letting me choose?

We're not talking about breech deliveries here. This post is specifically about elective inductions. Obviously, in your case, there were two options with no clear "winner". The science is very clear that elective induction leads to more (unnecessary) sections, which have a higher rate of complications and death for mom and baby than vaginal birth.

IME, you're doctor did exactly the right thing. He, as the medical professional, presented you with to equally valid courses of treatment, (I'm assuming here) informed you fully of the risks and benefits of each, and allowed you to choose. That's what should be happening in delivery rooms in this country.

Instead, what happens is doctors decide what is best or easiest for them, and push moms in that direction whether it's truly best for mom and baby or not. And because of the way the system is set up, mom can't make an informed choice in a lot of cases. This is a tragedy.

 Also, the fact that your doctor knew how to deliver a breech vaginally and gave you the option makes me want to find him and hug him.  

meltoine

Nechie122- I'm eliminating the quotes so this doesn't get unreadably long.

Should women be able to make the choices they want, within reason...?

It depends what you mean by "within reason". See my post to AmyRI. If the decision is between two choices with similar amounts of risk and no clear, scientifically proven, right path, then sure. But we know that elective induction increases risk and doesn't help moms and babies. This is a fact.

It's absolutely terrifying to go post-dates when you have a family history of fetal demise. But these issues are not hereditary. Someone who's mother and sister have post-dates stillbirths is at no higher risk for a post-dates stillbirth herself. However, if she and her doctor choose elective induction, especially if her Bishop Score is not favorable, she and her baby are at a higher risk of complications and death. That's what the science tells us.

In no other specialty do we allow patients to choose a course of treatment not appropriate for their condition because they want to, or because it will make them feel better emotionally. We absolutely do not let them do this for their children when science proves that the best treatment is something else. We expect doctors to counsel their their patients on the viable options and treat them with appropriate, effective therapy that doesn't unnecessarily increase their risk of complication and death, and we sue them when they fail. Why is obstetrics so backwards? 

tokenhoser

I hang on the Proboard where the Nest went, and here's what I notice when we talk about birth:

-tons and tons of induction stories

-leading to tons and tons of "labour was the worst thing I could ever imagine" stories

-cue the "epidurals are gift from God" refrains

-"even though I had to have a c-section. It was for the good of the baby! It saved her life."

I really do think getting a handle on elective (be it elected by the doctor or patient, just elective for no particular medical indication) would help stop that cascade. Imagine if we poured every dollar saved into providing in-hospital doulas for every labouring mother... we could get that cascade going the other way and provide a supportive, knowledgeable, positive birth environment for every birth instead. 

ILoveRunning

tokenhoser:

I hang on the Proboard where the Nest went, and here's what I notice when we talk about birth:

-tons and tons of induction stories

-leading to tons and tons of "labour was the worst thing I could ever imagine" stories

-cue the "epidurals are gift from God" refrains

-"even though I had to have a c-section. It was for the good of the baby! It saved her life."

I really do think getting a handle on elective (be it elected by the doctor or patient, just elective for no particular medical indication) would help stop that cascade. Imagine if we poured every dollar saved into providing in-hospital doulas for every labouring mother... we could get that cascade going the other way and provide a supportive, knowledgeable, positive birth environment for every birth instead. 

I agree that stopping the cascade of interventions would be a very positive thing, and I do think that there is some recognition that change needs to happen.  I don't have the link, but a number of medical organizations came forward to put together a list of medical tests/procedures that are overprescribed, and ACOG listed #1 and #2 items were both related to induction.  Inductions before 39 weeks for non-medical reasons are often banned at hospitals (see the b****ing and moaning on the skeptical ob blog for evidence of that).  Now attention needs to shift to push doctors to do a better job of informing patients of the risks of induction.

But I have to wholeheartedly disagree with you on a the idea that the money saved should be put into things like a universal doula program, or other measures that specifically promote natural birth.  The U.S. (and I know Canada is different) does not have a high childbirth morbidity/mortality rate because of epidurals, but because a large segment of the population does not have access to adequate health care.  Seeing money spent on programs to improve the health of expectant mothers would likely have the most significant impact on improving outcomes related to complications during child birth. 

tokenhoser

Doulas can support ALL kinds of births, and in-hospital doulas DO support all kinds of births. I just think it would close some of the gap on "not all mothers have the ability/time/skills/desires to be fully informed and engaged in birth" argument.

Specifically, I find this article REALLY interesting:

https://www.sciencedaily.com/releases/2008/05/080529162613.htm

"

Over a 5-year period, 224 of a group of 420 pregnant women in their third trimester were randomized to have a doula accompany them during labor, and 196 women did not receive this intervention. Cesarean delivery rates decreased by 12%, the need for an epidural dropped by 11%, and the need for a cesarean after induced labor decreased by 46% when a doula arrived shortly after hospital admission and remained with the woman throughout her labor and delivery when compared with the group without a doula.

Support from the doula included close physical proximity, touching, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her partner during the birth. On questionnaires administered the day after delivery, 100% of couples with doula support rated their experience with the doula positively."

 

AmyRI

meltoine:

We're not talking about breech deliveries here. This post is specifically about elective inductions. Obviously, in your case, there were two options with no clear "winner". The science is very clear that elective induction leads to more (unnecessary) sections, which have a higher rate of complications and death for mom and baby than vaginal birth.

IME, you're doctor did exactly the right thing. He, as the medical professional, presented you with to equally valid courses of treatment, (I'm assuming here) informed you fully of the risks and benefits of each, and allowed you to choose. That's what should be happening in delivery rooms in this country.

Instead, what happens is doctors decide what is best or easiest for them, and push moms in that direction whether it's truly best for mom and baby or not. And because of the way the system is set up, mom can't make an informed choice in a lot of cases. This is a tragedy.

 Also, the fact that your doctor knew how to deliver a breech vaginally and gave you the option makes me want to find him and hug him.  

Sure, it's not the same as an elective induction for sure. But there can be gray areas in when to induce as well. If there's absolutely no issues and no previous pregnancies, and an unfavorable Bishop score, it's easy to say "you shouldn't be induced." But if the opposite is true, there might be and it warrants a discussion of risks both ways and I truly believe it should not just be left to the professionals to decide. 

I agree with you that no matter the circumstances, the push should be to create informed providers and informed mothers. I do not want someone else making decisions about my body and if I harm myself, having been informed of the risks, that's my own problem (and my care provider is not liable for my decision). I'm sure that many women would not have made the decision that I did, but I would not either of us to be forced into one path.

I wish the original post had said, "I'm worried that someone I know hasn't discussed the reasons to and risks of induction with her doctor before deciding to induce."

(And I want to hug that OB, too. I'll probably never see him again, though, as he was the hospital's on-call OB and I see a midwife. He did fully inform us of the risks of both options. He sat casually in the armchair in the L&D room, having a very personal conversation with us, patiently waiting for contractions to pass if needed. He really made us feel like the decision was ours to make, and I will forever be grateful for that.)

nosoup4u

tokenhoser:

Doulas can support ALL kinds of births, and inhospital doulas DO support all kinds of births. I just think it would close some of the gap on "not all mothers have the ability/time/skills/desires to be fully informed and engaged in birth" argument. Specifically, I find this article REALLY interesting:https://www.sciencedaily.com/releases/2008/05/080529162613.htm "Over a 5year period, 224 of a group of 420 pregnant women in their
third trimester were randomized to have a doula accompany them during
labor, and 196 women did not receive this intervention. Cesarean
delivery rates decreased by 12, the need for an epidural dropped by
11, and the need for a cesarean after induced labor decreased by 46
when a doula arrived shortly after hospital admission and remained with
the woman throughout her labor and delivery when compared with the group
without a doula.
Support from the doula included close physical proximity, touching,
and eye contact with the laboring woman, and teaching, reassurance, and
encouragement of the woman and her partner during the birth. On
questionnaires administered the day after delivery, 100 of couples with
doula support rated their experience with the doula positively."nbsp;

Prenatal care is a real concern in the US, tho. Getting women covered and taken care of is s bigger priority, IMO. Tho I'm sure universal doulas would be inexpensive.

There's also doctors who only work at hospitals. Laborists, I think? Or having more MWs. All viable options.

jess9802

meltoine:

Nechie122- I'm eliminating the quotes so this doesn't get unreadably long.

Should women be able to make the choices they want, within reason...?

It depends what you mean by "within reason". See my post to AmyRI. If the decision is between two choices with similar amounts of risk and no clear, scientifically proven, right path, then sure. But we know that elective induction increases risk and doesn't help moms and babies. This is a fact.

It's absolutely terrifying to go post-dates when you have a family history of fetal demise. But these issues are not hereditary. Someone who's mother and sister have post-dates stillbirths is at no higher risk for a post-dates stillbirth herself. However, if she and her doctor choose elective induction, especially if her Bishop Score is not favorable, she and her baby are at a higher risk of complications and death. That's what the science tells us.

In no other specialty do we allow patients to choose a course of treatment not appropriate for their condition because they want to, or because it will make them feel better emotionally. We absolutely do not let them do this for their children when science proves that the best treatment is something else. We expect doctors to counsel their their patients on the viable options and treat them with appropriate, effective therapy that doesn't unnecessarily increase their risk of complication and death, and we sue them when they fail. Why is obstetrics so backwards? 

I am one whose mother and aunt had postdates stillbirths with their first pregnancies, and it was absolutely terrifying. The most my OB could tell me is that there may be some hereditary component to going into labor and that if my mother did not naturally go into labor before 42 weeks, there might be an increased risk of the same thing happening to me.

Personally speaking, if you have never experienced frank terror about your baby dying before birth, then I'm happy for you. It was a miserable way to spend my pregnancy. The anxiety only increased as I approached my due date. The rub in an anxiety disorder is that you're not thinking rationally, so knowing that my risk of stillbirth was no higher because of the family history didn't make a difference. In the end, I firmly believed that both my physical AND mental health mattered.

I was as educated on childbirth as anyone posting on this board. I knew quite well the risks of an induction or C-section. I had to balance those risks against the risks of waiting to go into labor naturally, especially since, in addition to the mental health aspects, I was also a chronic hypertensive. I knew that the risks of a C-section accrued primarily to me as opposed to my baby. I had in my mind a priority list of what mattered to me in labor, delivery, and birth. And so, together with my OB, who has over 25 years experience practicing medicine and has delivered thousands upon thousands of babies (with a current primary C-section rate of just 7%), we together made the decision to induce at 39 weeks. It didn't qualify as an elective induction.

But of course, if someone who was friends with me on Facebook didn't know the whole story (and most people didn't), they would never know that the induction was medically indicated. Maybe I too could have had some snide know-it-all posting on The Bump about her frustration over MY medical care and the choice I made, never knowing it was informed and thoughtfully made. THAT is my objection to Beany's post and the others I regularly see on this board. 

Nechie122

jess9802:

meltoine:

Nechie122- I'm eliminating the quotes so this doesn't get unreadably long.

Should women be able to make the choices they want, within reason...?

It depends what you mean by "within reason". See my post to AmyRI. If the decision is between two choices with similar amounts of risk and no clear, scientifically proven, right path, then sure. But we know that elective induction increases risk and doesn't help moms and babies. This is a fact.

It's absolutely terrifying to go post-dates when you have a family history of fetal demise. But these issues are not hereditary. Someone who's mother and sister have post-dates stillbirths is at no higher risk for a post-dates stillbirth herself. However, if she and her doctor choose elective induction, especially if her Bishop Score is not favorable, she and her baby are at a higher risk of complications and death. That's what the science tells us.

In no other specialty do we allow patients to choose a course of treatment not appropriate for their condition because they want to, or because it will make them feel better emotionally. We absolutely do not let them do this for their children when science proves that the best treatment is something else. We expect doctors to counsel their their patients on the viable options and treat them with appropriate, effective therapy that doesn't unnecessarily increase their risk of complication and death, and we sue them when they fail. Why is obstetrics so backwards? 

I am one whose mother and aunt had postdates stillbirths with their first pregnancies, and it was absolutely terrifying. The most my OB could tell me is that there may be some hereditary component to going into labor and that if my mother did not naturally go into labor before 42 weeks, there might be an increased risk of the same thing happening to me.

Personally speaking, if you have never experienced frank terror about your baby dying before birth, then I'm happy for you. It was a miserable way to spend my pregnancy. The anxiety only increased as I approached my due date. The rub in an anxiety disorder is that you're not thinking rationally, so knowing that my risk of stillbirth was no higher because of the family history didn't make a difference. In the end, I firmly believed that both my physical AND mental health mattered.

I was as educated on childbirth as anyone posting on this board. I knew quite well the risks of an induction or C-section. I had to balance those risks against the risks of waiting to go into labor naturally, especially since, in addition to the mental health aspects, I was also a chronic hypertensive. I knew that the risks of a C-section accrued primarily to me as opposed to my baby. I had in my mind a priority list of what mattered to me in labor, delivery, and birth. And so, together with my OB, who has over 25 years experience practicing medicine and has delivered thousands upon thousands of babies (with a current primary C-section rate of just 7%), we together made the decision to induce at 39 weeks. It didn't qualify as an elective induction.

But of course, if someone who was friends with me on Facebook didn't know the whole story (and most people didn't), they would never know that the induction was medically indicated. Maybe I too could have had some snide know-it-all posting on The Bump about her frustration over MY medical care and the choice I made, never knowing it was informed and thoughtfully made. THAT is my objection to Beany's post and the others I regularly see on this board. 

She's going to come back and bless your birth experience and say it was okay because YOUR induction was well thought out. She just won't give other women and their doctors the same credit.

It doesn't bother me that some women want a medically managed, highly controlled birth experience. And, no, actually obstetrics isn't the only medical specialty where we allow patients to determine their treatment plans based on their own preferences.

What bothers me is that we have no choice EXCEPT a medically managed, highly controlled birth experience because that's what states, hospitals and insurance companies dictate is best for us.

Talking about big picture ways to reduce the number of early inductions is one thing. Haranguing individual women over their birth choices is counterproductive.

iris427

ILoveRunning:

tokenhoser:

I hang on the Proboard where the Nest went, and here's what I notice when we talk about birth:

-tons and tons of induction stories

-leading to tons and tons of "labour was the worst thing I could ever imagine" stories

-cue the "epidurals are gift from God" refrains

-"even though I had to have a c-section. It was for the good of the baby! It saved her life."

I really do think getting a handle on elective (be it elected by the doctor or patient, just elective for no particular medical indication) would help stop that cascade. Imagine if we poured every dollar saved into providing in-hospital doulas for every labouring mother... we could get that cascade going the other way and provide a supportive, knowledgeable, positive birth environment for every birth instead. 

I agree that stopping the cascade of interventions would be a very positive thing, and I do think that there is some recognition that change needs to happen.  I don't have the link, but a number of medical organizations came forward to put together a list of medical tests/procedures that are overprescribed, and ACOG listed #1 and #2 items were both related to induction.  Inductions before 39 weeks for non-medical reasons are often banned at hospitals (see the b****ing and moaning on the skeptical ob blog for evidence of that).  Now attention needs to shift to push doctors to do a better job of informing patients of the risks of induction.

But I have to wholeheartedly disagree with you on a the idea that the money saved should be put into things like a universal doula program, or other measures that specifically promote natural birth.  The U.S. (and I know Canada is different) does not have a high childbirth morbidity/mortality rate because of epidurals, but because a large segment of the population does not have access to adequate health care.  Seeing money spent on programs to improve the health of expectant mothers would likely have the most significant impact on improving outcomes related to complications during child birth. 

Yeah.  I know Token is Canadian, but I agree in the US that if we want to improve perinatal outcomes, guaranteeing access to prenatal care is essential.  

As some of you may know, I was a hospital-based doula like the ones being discussed here.  It was an amazing, rewarding job.  It was also incredibly frustrating and sometimes demoralizing, because despite our presence, the hospital culture didn't change.  Women were strapped to monitors, prohibited from having anything but ice chips, not allowed to have water births, etc. etc. The hospital could only afford to pay 2 doulas per shift, so we were limited in the number of moms we could serve. And after a few years of the program, the hospital powers that be decided it was costing too much money and gave it the ax.   

So while I am a huge advocate of doulas and would love to see hospitals have doula programs, I don't think it is realistic, especially in a country where things like offering prenatal care to poor women and health care coverage to children is still controversial.  And I'm not sure how much it would change things. 

tokenhoser

Well, I was trying to answer a question about inductions and how we could think about that problem.

I think if instead the answer to everything is "but we don't provide prenatal care to poor women", that's valid. Really, really sad, but valid.

This board is kind of a downer.

iris427

meltoine:

 Why should we make allowances for people to choose medical procedures that are not evidence based just because they feel like it? 

Medical care, especially when we pay for it communally (as in group insurance plans or socialized healthcare) has to be about the treatment that is right for the patient, not what will give the patient a warm fuzzy feeling inside at a high cost to our maternal and infant mortality and morbidity rates, as well as our wallets.

Im sorry, but I just don't see room here for making allowances for people's uneducated or miseducated opinions, be those people doctors or patients, but especially wen those people are doctors whom we pay to be educated about these issues. Opinion is not science or fact, and medical decisions need to be based on science and fact.  

I think this is one of the more disturbing things I have read on this board.  Do you actually think we should take away a woman's personal freedom to make their own medical decisions and have a say about what happens to their body in service of the natural birth movement's values?  

Who gets to decide which medical treatments are approved and which aren't?  A hospital board?  We've seen how that turns out--bye bye VBAC.  ACOG? So long, home birth. The government?  Because our government doesn't have more pressing issues than whether Suzy Jones in Springfield should induce at 41 weeks or not.

And how do we always know what the evidence says?  Let's taking inducing for postdates at 41 weeks, for example.  Well, we know inducing a FTM doubles her chance of having a c/s.  But that is an average, and it varies depending on her Bishop score and how she is induced.  We also know that the rate of stillbirth increases every week at term.  We also know there are studies showing that while inducing at 41 weeks is reasonable in comparison to waiting at 42, inducing at 41 weeks results in a lower rate of cesarean section, meconium passage, and other complications.  So what is the "evidence-based approach" here?  Do you induce at 41 weeks or not? 

"Science and fact" are not always as clear cut as you are making them out to be.  

iris427

tokenhoser:

Well, I was trying to answer a question about inductions and how we could think about that problem.

I think if instead the answer to everything is "but we don't provide prenatal care to poor women", that's valid. Really, really sad, but valid.

This board is kind of a downer.

U.S. health care is a real downer.  When I was a doula, most of my clients were on Medicaid and thank god for that program.  And now there is a lot of talk about cutting Medicaid from certain politicians.  Most of our moms lived in neighborhoods that were impoverished and riddled with crime.  We had moms come in with no prenatal care at all.  We had moms come alone on the bus to give birth.  We had one mother who was around 8 months along and got shot in a drive-by shooting--thankfully she and her baby were ok.  A lot of them did not speak English, so you can imagine how that complicated issues like informed consent.   It could be very hard emotionally at times.

meltoine

It's not my place to bless anyone's birth experience and tell them they did the right thing, just like its not my place to malign them and tell them that they did the wrong thing. I wasn't there. I haven't read their charts. 

The bottom line is the maternity care in this country is in a sad state. And by not changing anything, we're not going to change anything. If half of the c-sections in this country are unnecessary (and they are, according to WHO) then that means that half of the women who have c-sections in this country have doctors who did the wrong thing. Pointing that out should not be cause for pearl clutching. It's logic. Well-educated doctors and midwives should be responsibly educating their patients and making these decisions together, as they're the ones with the complete picture from which to judge. Our problem is that we don't have well educated OBs in this country. Education in medical school is sorely lacking, given that most OBs admit to never having seen a normal birth during school or even residency and that things like breech delivery are not even taught anymore. Add to that the extreme lack of continuing education, as evidenced by the fact that many OBs don't even read the research or recommendations of their own professional organization and definitely don't follow them, and you get to where we are now.  

I maintain my position that women should not have the ability to choose whatever birth-related procedures they want without regard to the risk, benefit, or cost. If an individual woman operated in a vacuum and her choice affected only herself, sure, but that's not the case here. Her choice affects her child, her doctor, her hospital, and everyone else in her insurance group. There is a reason we don't let people walk into a doctor's office or ER with their own Dr. Google diagnosis and demand whatever treatment they feel is necessary. That reason is because they are often wrong. They didn't go to medical school and they don't keep up with the latest medical research. The problem with obstetrics is that the doctors don't keep up either.

We are 51st in the world for maternity care outcomes. We also, by far and away, spend the most on each mother-baby pair that comes through our hospital doors. What are we getting for that money? More dead babies and more dead moms.  We are doing something wrong and it needs to change. Immediately.  

beany02

I havent checked this board in a while but im surprised to see the conversation is still going. Thanks MidwestSeashell for this post....I definitely think a lot of people jumped on me for being judgemental rather than addressing the root issue of my post. People are attacking the specifics of where i got my facts: "How could she know about this woman's birth if they arent even friends, etc." I know because the rest of my family is close to her, my mom is a nurse and spent a lot of time in the hospital with her after her csection, and all the details of her induction were discussed with my mom and she shared them with me. I know about my other friends' past inductions because they specifically told me they were getting induced because they were past their due date...thats it. My best friend was induced with both her boys and told me after the second that she wished she would have been "allowed" to go into labor naturally. It didnt even occur to her that she is allowed to do whatever she wants with her own body! thats what my issue is. I'm upset that the mentality of birth is that doctor knows best and women (generally) arent questioning it or taking back control of their own experience. My stepbrothers wife is another example of that, i know many of you want to believe that i know nothing and there must have been a medical reason and i am just making assumptions and being judgemental....i can assure you that is NOT the case, there really wasnt a medical reason other than being past her due date!!!

Somebody said earlier in this thread that i was asking permission from the peanut gallery to post a snarky comment on her facebook page, not sure where that came from. I never said i was going to do that, i said i was going to keep my mouth shut because its not my place to make comments to her on her birth. i am making ANONYMOUS comments on this board because i wanted to discuss an issue that concerned me. Maybe i didnt explain it in a proper and polite way, but im not one for bs and frankly i was under the impression we could just be real here.

Midwest Seashell asked the question: "How can we best support mothers and families?" in my opinion, helping them realize that they are the ones in control of their bodies and their babies is the best way to support them. The stories of my friends lead me to believe that they think they have no power in their births. That they MUST follow doctor's orders and not ask why. When i asked two of them why they were induced, they said "because my doctor said he would." ......? But it isnt socially acceptable to say to a pregnant women, "listen, you mentioned induction but i want you to reconsider because of xyz." ****IM NOT REFERRING TO MEDICALLY NECESSARY INDUCTIONS****

God forbid i am labeled as judgemental but how do you know if my stepbrother's wife had gone into labor naturally, on her own, that her baby would NOT be in the NICU? It is a very real possibility that he would have been perfectly healthy. He is home now and doing great, but maybe he wouldnt have had to spend two days there. Why is it not ok to ask this question??